Running head: CLINICAL NURSING JUDGMENT 1

Clinical Nursing Judgment

Cassandra LaRose

Youngstown State University

CLINICAL NURSING JUDGMENT 2

Nursing is not as it used to be. Overtime nursing has become more knowledge based and

required nurses to have proper training and pristine assessment skills. We no longer just do as the

doctor says without the knowledge of why we are doing it. We have to use our judgment and

ensure that what we are doing is right for the patient. As defined by Seidi, Alhani and Salsali

(2015) clinical nursing judgment is “a prerequisite for establishing professional identity and is

mainly based on nurses’ knowledge and experience as well as their reasoning, intuition, clinical

thinking, and evidence-based practice skills” (p. 1). Clinical nursing judgment is important to

ensure the safety and well being of our patients. Clinical nursing judgment essentially just means

making the best decision for the best patient outcome using our learned knowledge and skills.

A great example of using clinical nursing judgment is a nurse checking a patient’s blood pressure

and pulse before administering a medication that could lower blood pressure such as a beta-blocker or

narcotic. If the blood pressure is too low the nurse would know to contact the healthcare provider and ask

if they still wanted the medication given. In this situation using clinical nursing judgment the nurse would

save the patient from a potential complication that can be avoided.

One of the very first classes that we take in nursing school teaches us the importance of

nursing assessments and using our clinical judgment in order to provide the best possible

outcomes for our patients; this is achieved through following the nursing process. According to

Van Graan, Williams, and Koen (2016) “The nursing process has dominated nursing education

since the 1960's as theorists tried to link their theories with the clinical judgment process and to

link nursing theory with clinical practice” (p. 281). A nurse has to be able to look at the whole

picture and act quickly in order to ensure the best outcome for their patient.

Having sound clinical nursing judgment is essential to working as a nurse and caring for

acutely ill patients especially with the acuity of patients increasing. Graan and Williams (2017)
CLINICAL NURSING JUDGMENT 3

stated “if nurse graduates do not have the ability to think critically or have poor clinical

reasoning skills they often fail to detect impending patient deterioration, including failure to

synthesize and act on clinical information resulting in a failure-to-rescue which effects quality

care and patient safety” (p. 276). New nurses need to come out of nursing school with the ability

to use clinical nursing judgment even as new nurses. I love that YSU has us prepared to think

critically and not just be proficient with skills.

As stated above sound clinical nursing judgment not only requires the skills and

knowledge to provide effective patient care, but also the experience. Manetti (2018) stated

“reflection‐on‐action is a self‐evaluative process used to learn and develop improved clinical

judgment from an experience” (p.103). This is why it is so important to ensure that new

graduates are given the opportunity to take care of patients before they are on the floor by

themselves. Using learned clinical judgment skills to monitor patient status and clinical data

regarding the patient are essential and new nurses need to be able to detect abnormal values in

their patients through their strong developed assessment skills and ability to apply their findings

to what is going on with their patient.

I have personally had a few experiences that I was able to apply my nursing knowledge

and clinical judgment in order to ensure patient safety and detect an error. One night in the ER I

was taking care of a patient that had come in for abdominal pain. The patient was prescribed

zofran and toradol. As I was standing at the pyxis I looked over at my preceptor and said “the

patient told me that she is breastfeeding. Are these medications able to be given?” The nurse

replied with “we should check that with pharmacy to make sure”. We called pharmacy and the

medications were able to be given in this case. But had I not used my judgment to ensure the
CLINICAL NURSING JUDGMENT 4

medications were safe with breastfeeding and they had not been, we could have harmed the

baby.

Another situation that I applied my clinical nursing judgment in was again with a

medication. The patient came into the emergency room complaining of shortness of breath. The

patient had congestive heart failure. The prescriber ordered 40 mg of furosemide. The patient

needed the furosemide due to fluid overload. Before administering the furosemide I checked the

patient’s blood pressure. The blood pressure was 90/50.

I was uneasy about giving the medication. Although I know the patient was in fluid

overload, I knew that furosemide would lower the blood pressure. I went to the doctor and

informed him of the patient’s blood pressure and ensured that he wanted me to still give this

dose. The doctor said to give the 40mg because we needed to get the fluid off and it shouldn’t

affect his blood pressure that much. In questioning the order I protected myself and the patient. If

I had just given that medication to the patient without questioning the order and the patient’s

blood pressure tanked I would have been held responsible and the patient would have suffered

from it.

In conclusion, nurses must have sound clinical nursing judgment and knowledge in order

to ensure the safety and well being of their patients. While my experiences in using clinical

nursing judgment ended up being okay, if I had not questioned those orders and had a negative

outcome I would have been the one to blame. Nursing is not just about passing meds and

completing tasks. YSU has prepared me to go into my nursing career ready to take care of

patients and use my learned clinical nursing judgment skills in order to protect my patient and

provide the best care.

CLINICAL NURSING JUDGMENT 5

References

Graan, A. C., & Williams, M. J. (2017). A conceptual framework to facilitate clinical judgement

in nursing: A methodological perspective. Health SA Gesondheid, 22, 275-290.

doi:10.4102/hsag.v22i0.1015

Graan, A. C., Williams, M. J., & Koen, M. P. (2016). Professional nurses understanding of

clinical judgement: A contextual inquiry. Health SA Gesondheid, 21, 280-293.

doi:10.1016/j.hsag.2016.04.001

Manetti, W. (2018). Sound clinical judgment in nursing: A concept analysis. Nursing Forum,

54(1), 102-110. doi:10.1111/nuf.12303

Seidi, J., Alhani, F., & Salsali, M. (2015). Nurses’ Clinical Judgment Development: A

Qualitative Research in Iran. Iranian Red Crescent Medical Journal,17(9), 1-8.

doi:10.5812/ircmj.20596